NPI | 1205391687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111925) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9111925) |
Enumeration Date | 2019-02-09 |
Last Update Date | 2025-10-01 |